Clinical Review

ABC of clinical haematology: Bone marrow and stem cell transplantation

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7088.1179 (Published 19 April 1997) Cite this as: BMJ 1997;314:1179
  1. Andrew Duncombe

    History

    Experiments in the 1950s showed that haemopoiesis could be restored in irradiated animals by engraftment of transfused marrow. Attempts to translate this into clinical practice were hindered by immunological problems of transfer between individuals which we now recognise as rejection and graft versus host disease.

    With further understanding of the human leucocyte antigen system, rapid clinical progress was made during the 1970s such that bone marrow transplantation soon became an established treatment for some immune deficiency and malignant diseases.

    Early animal studies of bone marrow transplantation were translated into clinical practice with understanding of the human leucocyte antigen (HLA) system and immunosuppressive therapy

    What is a bone marrow transplant?

    Transplant terminology.

    Transplantation is the reconstitution of the full haemopoietic system by transfer of the pluripotent cells present in the bone marrow (stem cells). This usually requires prior ablation of the patient's own marrow by intensive chemotherapy or chemoradiotherapy.

    The most appropriate generic term for the procedure is haemopoietic transplantation, which may be subdivided according to the donor source and further subdivided into the site of stem cell procurement.

    Allogeneic transplantation is when another individual acts as the donor–usually a sibling of the patient, sometimes a normal volunteer. All cases, however, require a full or near HLA match–that is, they should be HLA compatible. Autologous transplantation is when the patient acts as his or her own source of stem cells.

    The aim of haemopoietic transplantation is the elimination of the underlying disease in the recipient, together with full restoration of haemopoietic and immune function

    Originally, stem cells were procured from the bone marrow by direct puncture and aspiration of bone marrow and reinfused intravenously, a procedure known as bone marrow transplantation. Recently, it has been shown that stem cells derived from the bone marrow can be liberated into the peripheral blood, where the cells are harvested with …

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